---

Out-of-Hours Care

In the light of Madam Deputy Speaker's ruling at the outset of this debate that the case of my constituent, Mr. David Gray, remains sub judice until the inquest on his death finishes next week, I shall not allude to it any further. However, I put on record my intention to pursue a proper debate on the circumstances surrounding his tragic death and subsequent developments at a later time and through other means. I am sure that Mr. Gray's family will greatly appreciate the offer of condolences that the Minister made in his opening remarks. Several cases in the media in the past years—and not just the case that is currently sub judice—have highlighted the failure of the out-of-hours care system. All too often, we hear similar stories of patients not receiving the out-of-hours care that they are entitled to under the NHS. Currently, the shortage of out-of-hours GPs is largely met by foreign doctors who register to work as supply doctors in England, but the system does not adequately ensure that these foreign doctors are fit for practice. Loopholes in the out-of-hours system have enabled some foreign doctors who should never have been allowed to work as GPs in this country to do so, at great cost to patients' welfare and safety. In the absence of any root-and-branch reform of the system or a change of Government leading to GP commissioning as outlined by my hon. Friend the Member for Boston and Skegness (Mark Simmonds) in his opening speech, I should like to focus on the use of foreign doctors in out-of-hours provision and to suggest a few proposals for reform that might go some way to ensure that patients receive the high standard of care to which they are entitled under the NHS. My first proposal is that an assessment of English language skills should be carried out on all foreign doctors, because too many patients complain of foreign doctors' often limited knowledge of our language. We must ensure that all foreign doctors who register to work in Britain have a sufficiently good grasp of English to diagnose appropriately and to treat patients. Misunderstandings and unawareness can cost lives, particularly as many EU doctors are apparently unfamiliar with the strength of some drugs that are used in the NHS. As the Minister confirmed, many primary care trusts require a high level of English proficiency before a foreign doctor can register as a GP. However, the system allows for loopholes to be exploited, as not all PCTs have such high standards. The loophole enables foreign doctors who would not pass the English requirement set by some PCTs simply to apply to others that do not have such stringent rules. Even worse is the fact that a doctor who fails an English test in one PCT can withdraw his application from that PCT, leaving no trace or record in the system, before re-applying for an English test at another PCT. Thus, there is no record of a list of failures or rejections. In other words, a doctor can tout himself around the system until he finds a weakness and gets a breakthrough. Once a doctor is registered with a PCT, he or she can work as a GP anywhere in the country, regardless of the language requirements in the particular PCT area in which he or she ends up practising. The registration of foreign doctors with PCTs is an area where requirements must be standardised in order to avoid applicants exploiting such loopholes. As well as having these English language tests, it is crucial that the applicant's medical competence is assessed before they can register in the UK. Before being registered, doctors should be required to provide documentation to show that they have experience of working as a GP and that they have undergone specific training in general practice. All the applicant needs to do at the moment is to provide a licence to show that they are allowed to practise in their own country, regardless of whether they have actually ever worked as a general practitioner. I do not believe that that is enough, and more stringent rules are needed in this area to ensure the best possible care for patients. Compulsory training and induction in England before foreign doctors are allowed to work as GPs is also crucial to ensure a high level of patient care, a point made by the hon. Member for North Norfolk (Norman Lamb). That is not currently a legal requirement, and it would be interesting to hear of any plans the Government have to introduce compulsory training and induction for foreign doctors. The General Medical Council must consider introducing more stringent assessment before recognising medical qualifications from other EU states. Doctors from EU countries do not have to undergo the same assessment of their competence as doctors from other countries, not only those from India—that country has been mentioned—but those from countries such as Australia and the USA. It is necessary that the medical competence of doctors from EU countries should also be assessed, as medical training and types of drugs used vary across Europe. Criminal record checks should also be mandatory for all foreign doctors applying to work in our NHS and the country of origin should be obliged to supply information of previous malpractice by a doctor to the authorities in this country. At present, this is entirely voluntary, but there have been cases of doctors who have been convicted of malpractice in their own country being allowed to practise as out-of-hours GPs in our NHS. A national database of foreign doctors applying to work as a GP in Britain should be introduced that would hold information on language skills, levels of medical competence, criminal record checks, malpractice in the country of origin and whether the doctor has ever been rejected by, or withdrawn their application from, any PCT. Finally, as a general rule, doctors should be accountable to the laws of the country in which they practise. The Government must work with other countries to ensure that any doctor accused of malpractice, negligence or worse in this country is not allowed to escape justice being served for the crimes that they have committed. I hope that the Government will urgently consider the proposals for reform of the out-of-hours care system that I and many other hon. Members have proposed in the debate this evening. I call on the Government to ensure that foreign doctors are properly assessed and scrutinised before they are allowed to work as GPs in this country. We have witnessed too many cases where patients have been let down by the system and we need a complete overhaul of the provision of out-of-hours care in order properly to ensure the safety and well-being of patients. Until the Government bring in urgent and sweeping reforms to this system, people's lives will be at risk. Too many patients have had to pay with their lives already.